Department of Psychiatry, Trinity College Dublin, Ireland; Department of Psychiatry, St James's Hospital, Dublin, Ireland; Department of Psychiatry, University College Cork, Ireland.
National Hospital for Neurology and Neurosurgery, London, United Kingdom.
Schizophr Res. 2020 Aug;222:455-461. doi: 10.1016/j.schres.2019.11.023. Epub 2020 Jun 1.
N-methyl-d-aspartate receptor antibody (NMDAR-Ab) encephalitis consensus criteria has recently been defined. We aimed to examine the prevalence of NMDAR-Ab encephalitis in patients with first episode psychosis (FEP) and treatment resistant schizophrenia (TRS) on clozapine, using clinical investigations, antibody testing and to retrospectively apply diagnostic consensus criteria.
Adult (18-65 years old) cases of FEP meeting inclusion criteria were recruited over three years and assessed using the Structured Clinical Interview for DSM-IV disorders (SCID). NMDAR-Ab was identified using a live cell-based assay (L-CBA). Seropositive cases were clinically investigated for features of encephalitis including neuro-imaging, EEG and CSF where possible. Serum was retested using immunohistochemistry (IHC) as part of diagnostic criteria guidelines. A cohort of patients with TRS was also recruited.
112 FEP patients were recruited over 3 years. NMDAR-Ab seroprevalence was 4/112 (3.5%) cases. One case (<1%) was diagnosed with definite NMDAR-Ab encephalitis and treated with immunotherapy. One of the three other seropositive cases met criteria for probable encephalitis. However all three were ultimately diagnosed with mood disorders with psychotic features. None have developed neurological features at three year follow up. 1/100 (1%) of patients with TRS was 100 patients with TRS were recruited. One case (1%) seropositive for NMDAR-Ab but did not meet criteria for encephalitis.
NMDAR-Ab encephalitis as defined by consensus guidelines occured rarely in psychiatric services in this study. Further studies are needed to establish pathogenicity of serum NMDAR-Ab antibodies. Psychiatric services should be aware of the clinical features of encephalitis.
N-甲基-D-天冬氨酸受体抗体（NMDAR-Ab）脑炎的共识标准最近已经确定。我们旨在通过临床检查、抗体检测，并回顾性应用诊断共识标准，来研究在使用氯氮平治疗的首发精神病（FEP）和治疗抵抗性精神分裂症（TRS）患者中，NMDAR-Ab 脑炎的患病率。
在三年内招募了符合纳入标准的成年（18-65 岁）FEP 病例，并使用 DSM-IV 障碍的结构性临床访谈（SCID）进行评估。使用活细胞测定法（L-CBA）来识别 NMDAR-Ab。对于可能存在脑炎特征的病例，包括神经影像学、脑电图和脑脊液等，进行临床调查。作为诊断标准指南的一部分，对血清进行了重新免疫组化（IHC）检测。还招募了一组 TRS 患者。
在三年内招募了 112 名 FEP 患者。NMDAR-Ab 的血清阳性率为 4/112（3.5%）。1 例（<1%）被诊断为明确的 NMDAR-Ab 脑炎，并接受了免疫治疗。其他 3 例血清阳性病例中有 1 例符合可能脑炎的标准。然而，所有 3 例最终都被诊断为伴有精神病特征的心境障碍。在三年的随访中，没有出现神经学特征。在 100 名 TRS 患者中，有 1 名（1%）为 NMDAR-Ab 血清阳性，但不符合脑炎标准。
在本研究中，根据共识标准定义的 NMDAR-Ab 脑炎在精神科服务中很少见。需要进一步研究以确定血清 NMDAR-Ab 抗体的致病性。精神科服务机构应了解脑炎的临床特征。
